Class 9 and 10 Upper GI
When assessing a patient's abdomen, what would be most appropriate for the nurse to do? a. Palpate the abdomen before auscultation. b. Percuss the abdomen before auscultation. c. Auscultate the abdomen before palpation. d. Perform deep palpation before light palpation.
c. Auscultate the abdomen before palpation. During examination of the abdomen, auscultation is done before percussion and palpation because these latter procedures may alter the bowel sounds.
The nurse is reviewing the home medication list for a 44-year-old man admitted with suspected hepatic failure. Which medication could cause hepatotoxicity? a. Nitroglycerin b. Digoxin (Lanoxin) c. Ciprofloxacin (Cipro) d. Acetaminophen (Tylenol)
d. Acetaminophen (Tylenol) Many chemicals and drugs are potentially hepatotoxic (see Table 39-6) and result in significant patient harm unless monitored closely. For example, chronic high doses of acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs) may be hepatotoxic.
The ED nurse has inspected, auscultated, and palpated the abdomen with no obvious abnormalities, except pain. When the nurse palpates the abdomen for rebound tenderness, there is severe pain. The nurse should know that this could indicate what problem? a. Hepatic cirrhosis b. Hypersplenomegaly c. Gall bladder distention d. Peritoneal inflammation
d. Peritoneal inflammation When palpating for rebound tenderness, the problem area of the abdomen will produce pain and severe muscle spasm when there is peritoneal inflammation. Hepatic cirrhosis, hypersplenomegaly, and gall bladder distention do not manifest with rebound tenderness.
When a patient has a history of a total gastrectomy, the nurse will monitor for clinical manifestations of a. constipation. b. dehydration. c. elevated total cholesterol. d. cobalamin (vitamin B12) deficiency.
d. cobalamin (vitamin B12) deficiency. The patient with a total gastrectomy does not secrete intrinsic factor, which is needed for cobalamin (vitamin B12) absorption. Because the stomach absorbs only small amounts of water and nutrients, the patient is not at higher risk for dehydration, elevated cholesterol, or constipation.
When preparing a patient for a capsule endoscopy study, what should the nurse do? a. Ensure the patient understands the required bowel preparation. b. Have the patient return to the procedure room for removal of the capsule. c. Teach the patient to maintain a clear liquid diet throughout the procedure. d. Explain to the patient that conscious sedation will be used during placement of the capsule.
a. Ensure the patient understands the required bowel preparation. A capsule endoscopy study involves the patient performing a bowel prep to cleanse the bowel before swallowing the capsule. The patient will be on a clear liquid diet for 1 to 2 days before the procedure and will remain NPO for 4 to 6 hours after swallowing the capsule. The capsule is disposable and will pass naturally with the bowel movement, although the monitoring device will need to be removed.
A 35-year-old man with a family history of adenomatous polyposis had a colonoscopy with removal of multiple polyps. Which signs and symptoms should the nurse teach the patient to report immediately? a. Fever and abdominal pain b. Flatulence and liquid stool c. Loudly audible bowel sounds d. Sleepiness and abdominal cramps
a. Fever and abdominal pain The patient should be taught to observe for signs of rectal bleeding and peritonitis. Fever, malaise, and abdominal pain and distention could indicate a perforated bowel with peritonitis.
A patient had a stomach resection for stomach cancer. The nurse should teach the patient about the loss of the hormone that stimulates gastric acid secretion and motility and maintains lower esophageal sphincter tone. Which hormone will be decreased with a gastric resection? a. Gastrin b. Secretin c. Cholecystokinin d. Gastric inhibitory peptide
a. Gastrin Gastrin is the hormone activated in the stomach (and duodenal mucosa) by stomach distention that stimulates gastric acid secretion and motility and maintains lower esophageal sphincter tone. Secretin inhibits gastric motility and acid secretion and stimulates pancreatic bicarbonate secretion. Cholecystokinin allows increased flow of bile into the duodenum and release of pancreatic digestive enzymes. Gastric inhibitory peptide inhibits gastric acid secretion and motility.
Which action by nursing assistive personnel (NAP) when caring for a patient who has just returned to the nursing unit after an esophagogastroduodenoscopy (EGD) requires that the RN intervene? a. Offering the patient a glass of water b. Positioning the patient on the right side c. Checking the vital signs every 30 minutes d. Swabbing the patient's mouth with cold water
a. Offering the patient a glass of water Immediately after EGD, the patient will have a decreased gag reflex and is at risk for aspiration. Assessment for return of the gag reflex should be done by the RN. The other actions by the NAP are appropriate.
The health care provider sees a patient at 10 AM and writes an order for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which of these actions that are included in the agency policy for ERCP should the nurse take first? a. Place the patient on NPO status. b. Administer sedative medications. c. Ensure the consent form is signed. d. Explain the procedure to the patient.
a. Place the patient on NPO status. The patient will need to be NPO for 8 hours before the ERCP is done, so the nurse's initial action should be to place the patient on NPO status. The other actions can be done after the patient is NPO.
A 90-year-old healthy man is suffering from dysphagia. The nurse explains what age-related change of the GI tract is the most likely cause of his difficulty? a. Xerostomia b. Esophageal cancer c. Decreased taste buds d. Thinner abdominal wall
a. Xerostomia Xerostomia, decreased volume of saliva, leads to dry oral mucosa and dysphagia. Esophageal cancer is not an age-related change. Decreased taste buds and a thinner abdominal wall do not contribute to difficulty swallowing.
To palpate the liver, the nurse a. places one hand on the patient's back and presses upward and inward with the other hand below the patient's right costal margin. b. places one hand on top of the other and uses the upper fingers to apply pressure and the bottom fingers to feel for the liver edge. c. presses slowly and firmly over the right costal margin with one hand and withdraws the fingers quickly after the liver edge is felt. d. places one hand under the patient's lower ribs and presses the left lower rib cage forward, palpating below the costal margin with the other hand.
a. places one hand on the patient's back and presses upward and inward with the other hand below the patient's right costal margin. The liver is normally not palpable below the costal margin, the nurse needs to push inward below the right costal margin while lifting the patient's back slightly with the left hand. The other methods will not allow palpation of the liver.
A 62-year-old woman patient is scheduled for a percutaneous transhepatic cholangiography to restore biliary drainage. The nurse discusses the patient's health history and is most concerned if the patient makes which statement? a. "I am allergic to bee stings." b. "My tongue swells when I eat shrimp." c. "I have had epigastric pain for 2 months." d. "I have a pacemaker because my heart rate was slow."
b. "My tongue swells when I eat shrimp." The percutaneous transhepatic cholangiography procedure will include the use of radiopaque contrast medium. Patients allergic to shellfish and iodine are also allergic to contrast medium. Having a pacemaker will not affect the patient during this procedure. It would be expected that the patient would have some epigastric pain given the patient's condition.
Inspection of an older patient's mouth reveals the presence of white, curd-like lesions on the patient's tongue. What is the most likely etiology for this abnormal assessment finding? a. Herpesvirus b. Candida albicans c. Vitamin deficiency d. Irritation from ill-fitting dentures
b. Candida albicans White, curd-like lesions surrounded by erythematous mucosa are associated with oral candidiasis. Herpesvirus causes benign vesicular lesions in the mouth. Vitamin deficiencies may cause a reddened, ulcerated, swollen tongue. Irritation from ill-fitting dentures will cause friable, edematous, painful, bleeding gingivae.
The nurse should recognize that the liver performs which functions (select all that apply)? a. Bile storage b. Detoxification c. Protein metabolism d. Steroid metabolism e. Red blood cell (RBC) destruction
b. Detoxification c. Protein metabolism d. Steroid metabolism The liver performs multiple major functions that aid in the maintenance of homeostasis. These include metabolism of proteins and steroids as well as detoxification of drugs and metabolic waste products. The Kupffer cells of the liver participate in the breakdown of old RBCs. The liver produces bile, but storage occurs in the gall bladder.
Which assessment finding in a patient who is being admitted to the hospital is most important to report to the health care provider? a. Tympany onpercussion of the abdomen b. Liver edge 3 cm below the costal margin c. Bowel sounds of 20/minute in each quadrant d. Aortic pulsations visible in the epigastric area
b. Liver edge 3 cm below the costal margin Normally the lower border of the liver is not palpable below the ribs, so this finding suggests hepatomegaly. The other findings are within normal range for the physical assessment.
Which information collected by the nurse when caring for a patient who has just arrived in the recovery area after an upper endoscopy is most important to communicate to the health care provider? a. The patient is very sleepy. b. The oral temperature is 101.6° F. c. The apical pulse is 104 beats/minute. d. The patient complains of a sore throat.
b. The oral temperature is 101.6° F. A temperature elevation may indicate that a perforation has occurred. The other assessment data are normal immediately after the procedure.
The patient had a car accident and was "scared to death." The patient is now reporting constipation. What affecting the gastrointestinal (GI) tract does the nurse know could be contributing to the constipation? a. The patient is too nervous to eat or drink, so there is no stool. b. The sympathetic nervous system was activated, so the GI tract was slowed. c. The parasympathetic nervous system is now functioning to slow the GI tract. d. The circulation in the GI system has been increased, so less waste is removed.
b. The sympathetic nervous system was activated, so the GI tract was slowed. The constipation is most likely related to the sympathetic nervous system activation from the stress related to the accident. SNS activation can decrease peristalsis. Even without oral intake for a short time, stool will be formed. The parasympathetic system stimulates peristalsis. The circulation to the GI system is decreased with stress.
An 85-year-old woman seen in the primary care provider's office for a well check complains of difficulty swallowing. What common effect of aging should the nurse assess for as a possible cause? a. Anosmia b. Xerostomia c. Hypochlorhydria d. Salivary gland tumor
b. Xerostomia Xerostomia (decreased saliva production), or dry mouth, affects many older adults and may be associated with difficulty swallowing (dysphagia). Anosmia is loss of sense of smell. Hypochlorhydria, a decrease in stomach acid, does not affect swallowing. Salivary gland tumors are not common.
To promote bowel evacuation in a patient with chronic complaints of constipation, the nurse will suggest that the patient should attempt defecation a. in the mid-afternoon. b. after eating breakfast. c. right after getting up in the morning. d. immediately before the first daily meal.
b. after eating breakfast. These reflexes are most active after the first daily meal. Arising in the morning, the anticipation of eating, and physical exercise do not stimulate these reflexes.
The nurse will monitor a patient who has an obstruction of the common bile duct for a. melena. b. steatorrhea. c. decreased serum cholesterol levels. d. increased serum indirect bilirubin levels.
b. steatorrhea. A common bile duct obstruction will reduce the absorption of fat in the small intestine, leading to fatty stools. Gastrointestinal (GI) bleeding is not caused by common bile duct obstruction. Serum cholesterol levels are increased with biliary obstruction. Direct bilirubin level is increased with biliary obstruction.
When the nurse is assessing an alert and independent older patient in the clinic for malnutrition risk, the most appropriate initial question is, a. "How do you get to the grocery store to buy your food?" b. "Do you have any difficulty in preparing or eating food?" c. "Can you tell me the foods that you have eaten over the past 24 hours?" d. "Are you taking any medications that alter your taste or tolerance of foods?"
c. "Can you tell me the foods that you have eaten over the past 24 hours?" This question is the most open-ended and will provide the best overall information about the patient's daily intake and risk for poor nutrition. The other questions may be asked, depending on the patient's response to the first question.
When caring for the patient with heart failure, the nurse knows that which gastrointestinal process is most dependent on cardiac output and may affect the patient's nutritional status? a. Ingestion b. Digestion c. Absorption d. Elimination
c. Absorption Substances that interface with the absorptive surfaces of the GI tract (primarily in the small intestine) diffuse across the intestinal membranes into intestinal capillaries and are then carried to other parts of the body for use in energy production. The cardiac output provides the blood flow for this absorption of nutrients to occur.
A patient who is scheduled for surgery with general anesthesia in 1 hour is observed with a moist, but empty water glass in his hand. Which assessment finding may indicate that the patient drank a glass of water? a. Flat abdomen without movement upon inspection b. Tenderness at left upper quadrant upon palpation c. Easily heard, loud gurgling in the right upper quadrant d. High-pitched, hollow sounds in the left upper quadrant
c. Easily heard, loud gurgling in the right upper quadrant If the patient drank water on an empty stomach, gurgling can be assessed without a stethoscope or assessed with auscultation. High-pitched, hollow sounds are tympanic and indicate an empty cavity. A flat abdomen and tenderness do not indicate that the patient drank a glass of water.
The nurse is assessing a 50-year-old woman admitted with a possible bowel obstruction. Which assessment finding would be expected in this patient? a. Tympany to abdominal percussion b. Aortic pulsation visible in epigastric region c. High-pitched sounds on abdominal auscultation d. Liver border palpable 1 cm below the right costal margin
c. High-pitched sounds on abdominal auscultation The bowel sounds are more high pitched (rushes and tinkling) when the intestines are under tension, as in intestinal obstruction. Bowel sounds may also be diminished or absent with an intestinal obstruction. Normal findings include aortic pulsations on inspection and tympany with percussion, and the liver may be palpable 1 to 2 cm along the right costal margin.
The health care team is assessing a male patient for acute pancreatitis after he presented to the emergency department with severe abdominal pain. Which laboratory value is the best diagnostic indicator of acute pancreatitis? a. Gastric pH b. Blood glucose c. Serum amylase d. Serum potassium
c. Serum amylase Elevated serum amylase levels indicate early pancreatic dysfunction and are used to diagnose acute pancreatitis. Serum lipase levels stay elevated longer than serum amylase in acute pancreatitis. Blood glucose, gastric pH, and potassium levels are not direct indicators of acute pancreatic dysfunction.
Which information obtained by the nurse when admitting a patient who is scheduled for an ultrasound of the gallbladder indicates that the ultrasound may need to be rescheduled? a. The patient has a permanent gastrostomy tube. b. The patient took a laxative the previous evening. c. The patient ate a low-fat bagel an hour previously. d. The patient had a high-fat meal the previous evening.
c. The patient ate a low-fat bagel an hour previously. Food intake can cause the gallbladder to contract and result in a suboptimal study. The patient should be NPO for 8 to 12 hours before the test. A high-fat meal the previous evening, laxative use, or a gastrostomy tube will not affect the results of the study.
The nurse is performing an assessment of an 80-year-old patient. Which information obtained by the nurse will be of most concern? a. Decreased appetite b. Difficulty chewing food c. Unintentional weight loss d. Complaints of indigestion
c. Unintentional weight loss Unintentional weight loss is not a normal finding in older patients and may indicate a problem such as cancer or depression. Poor appetite, difficulty in chewing, and complaints of indigestion are common in older patients. These will need to be addressed, but are not of as much concern as the weight loss.
The patient tells the nurse she had a history of abdominal pain, so she had a surgery to make an opening into the common bile duct to remove stones. The nurse knows that this surgery is called a a. colectomy b. cholecystectomy c. choledocholithotomy d. choledochojejunostomy
c. choledocholithotomy A choledocholithotomy is an opening into the common bile duct for the removal of stones. A colectomy is the removal of the colon. The cholecystectomy is the removal of the gallbladder. The choledochojejunostomy is an opening between the common bile duct and the jejunum.
When caring for a patient following a needle biopsy of the liver at the bedside, the nurse should a. put pressure on the biopsy site using a sandbag. b. elevate the head of the bed to facilitate breathing. c. place the patient on the right side with the bed flat. d. check the patient's postbiopsy coagulation studies.
c. place the patient on the right side with the bed flat. After a biopsy, the patient lies on the right side with the bed flat to splint the biopsy site. Coagulation studies are checked before the biopsy. A sandbag does not exert adequate pressure to splint the site.
When the nurse is obtaining a history from a patient who is admitted with jaundice, which statement is most indicative of a need for patient teaching? a. "I used cough syrup several times a day last week." b. "I take a baby aspirin every day to prevent strokes." c. "I needto take an antacid for indigestion several times a week" d. "I use acetaminophen (Tylenol) every 4 hours for chronic pain."
d. "I use acetaminophen (Tylenol) every 4 hours for chronic pain." Chronic use of high doses of acetaminophen can be hepatotoxic and may have caused the patient's jaundice. The other patient statements require further assessment by the nurse, but do not indicate a need for patient education.
The nurse is performing a focused abdominal assessment of a patient who has been recently admitted. In order to palpate the patient's liver, where should the nurse palpate the patient's abdomen? a. Left lower quadrant b. Left upper quadrant c. Right lower quadrant d. Right upper quadrant
d. Right upper quadrant Although the left lobe of the liver is located in the left upper quadrant of the abdomen, the bulk of the liver is located in the right upper quadrant.
During change-of-shift report, the nurse receives the following information about a patient who is scheduled for a colonoscopy. Which information should be communicated to the health careprovider before sending the patient for the procedure? a. The patient has a permanent pacemaker to prevent bradycardia. b. The patient is worried about discomfort during the examination. c. The patient has had an allergic reaction to shellfish and iodine in the past. d. The patient refused to drink the ordered polyethylene glycol (GoLYTELY).
d. The patient refused to drink the ordered polyethylene glycol (GoLYTELY). If the patient has had inadequate bowel preparation, the colon cannot be visualized and theprocedure should be rescheduled. Because contrast solution is not used during colonoscopy, the iodine allergy is not pertinent. A pacemaker is a contraindication to magnetic resonance imaging (MRI), but not to colonoscopy. The nurse should instruct the patient about the sedation used during the examination to decrease the patient's anxiety about discomfort.
When the nurse is listening to a patient's abdomen, which finding indicates a need for a focused abdominal assessment? a. Loud gurgles b. High-pitched gurgles c. Absent bowel sounds d. Frequent clicking sounds
c. Absent bowel sounds Absent bowel sounds are abnormal and require further assessment by the nurse. The other sounds may be heard normally.
